Social and Behavioural Insights in Immunisation
Social and Behavioural Insights in Immunisation
Social and Behavioural Insights in Immunisation
Last week the SABII team and colleagues from NCIRS enjoyed an end-of-year lunch at the pub. Here are a few snaps of the team. It’s rare to have so many of us together in one place!
As another busy and successful year winds to a close, the SABII team would like to wish everyone a safe, restful and happy festive season. See you in the new year!
Congratulations to two of SABII’s team members who recently graduated, Dr Maria Christou-Ergos and Dr Belinda Bruce, pictured below with their supervisors Dr Kerrie Wiley, Prof Julie Leask and A/Prof Heather Shepherd. Also credit to A/Prof Brad de Vries, who also supervised Belle.
Dr Bruce’s thesis is titled: An examination of the administration of intravenous fluids to women during labour. Dr Christou-Ergos’ thesis is titled: Understanding vaccine hesitancy in relation to psychological trauma. Some of their findings can be found in the papers below:
The SABII team have been involved in the National Vaccination Insights project which surveyed a nationally representative cohort of 2,000 parents. The aim of the study was to understand the barriers to uptake of National Immunisation Program vaccines among children under 5 years of age.
The researchers have worked closely with the World Health Organization to adapt, pre-test and validate the Behavioural and Social Drivers (BeSD) of vaccination survey, which is being developed to support global efforts to better understand the drivers of adult flu vaccination.
A pre-print of the paper is available here: The Drivers of Influenza Vaccination in Adults: Insights from a National Australian Survey.
ABSTRACT
Influenza vaccination coverage is suboptimal in the Australian adult population. While coverage data is used to monitor uptake, at present, there is no systematic data collection on the behavioural and social drivers of vaccination. This study used a globally standardized survey tool to measure constructs related to influenza vaccination within four domains (i) vaccination-related thoughts and feelings, (ii) social processes, (iii) motivation, and (iv) practical issues.
An online survey was administered to a sample of 2055 Australian adults recruited via an online panel in March 2024. Logistic regression analysis was used to determine factors that contributed to people’s intention to receive an influenza vaccine.
Most Australian adults (62.8%) wanted an influenza vaccine in the upcoming influenza season. The odds of wanting an influenza vaccine were significantly greater for people who: had received an influenza vaccine in the preceding two years (aOR:10.35; 95% CI: 7.09-15.11) p<.001; thought the influenza vaccine offered personal protection (aOR:2.66; 95% CI: 1.76-4.01) p<.001; thought the influenza vaccine offered protection to others (aOR:1.6; 95% CI: 1.08-2.39) p=0.02; thought the influenza vaccine was important for their own health (aOR:1.53; 95% CI: 1.03-2.27) p=0.04; felt a social responsibility to get an influenza vaccine (aOR:4.05; 95% CI: 2.88-5.68) p<.001; believed close family and friends wanted them to get the influenza vaccine (aOR:2.35; 95% CI: 1.67-3.3) p<.001; believed community leaders wanted them to get the influenza vaccine (aOR:1.48; 95% CI: 1.08-2.01) p=0.01; received a recommendation to get the influenza vaccine from a health care worker in last two years (aOR:1.7; 95% CI: 1.24-2.32) p<.001.
This study provides a foundation for ongoing national monitoring of the drivers of influenza vaccination. This will help tailor timely strategies to population needs. Strategies that increase confidence in the value of vaccination, foster positive social norms within communities and increase access to vaccine services may help increase influenza vaccine acceptance.
Christou-Ergos, M., Sabahelzain, M. M., Steffens, M., Kaufman, J., Bolsewicz, K.T., Danchin, M., and Leask, J., The Drivers of Influenza Vaccination in Adults: Insights from a National Australian Survey (August 26, 2024). Available at SSRN: https://ssrn.com/abstract=4958283 or http://dx.doi.org/10.2139/ssrn.4958283
SBS reported on the study and also interviewed SABII’s Dr Ikram Abdi: The Australian vaccination trend some fear could be a ‘canary in the coal mine’.
Last week, Dr Majdi Sabahelzain, one of our SABII team, participated in a panel discussion on Delivering Healthcare and Protecting Civilians in Conflict Zones. Other panellists included Professor Catherine Renshaw, Dean of Law, Western Sydney University, Mr Jagan Chapagain, Chief Executive Officer and Secretary General, International Federation of the Red Cross and Red Crescent Societies, and Professor Emily Crawford, Professor, Sydney Law School. The University of Sydney. The discussion was moderated by Dr Megan Cox, Senior Lecturer at SSPH.
The discussion explored the ethical and practical challenges faced by healthcare workers in delivering impartial care amidst large-scale displacement, conflicts involving non-state actors, and protracted crises. It also highlighted the alarming frequency of human rights violations, particularly the attacks on health facilities and healthcare workers, and emphasised the need to abide by the international humanitarian law (IHL) in protecting not only civilians and healthcare providers but also wounded and sick combatants.
Dr. Majdi Sabahelzain highlighted the inequities in media coverage of crises, particularly in protracted conflicts and civil wars in countries that hold low geopolitical importance for donors. Mr Jagan Chapagain discussed further how this disparity affects global attention and results in insufficient support and resource allocation for crises in underreported regions.
The event was part of the annual Sydney Peace Prize, awarded this year to the International Federation of Red Cross and Red Crescent Movement. The event was hosted by the University of Sydney’s Faculty of Medicine and Health, in partnership with Sydney Peace Foundation, Sydney Law School, and Western Sydney University, with guests from the Western Sydney Local Health District and International Red Cross and Red Crescent Movement.
Check out two new publications from the SABII team, led by Dr Christou-Ergos. See the abstracts below, and click the links to see the full articles.
Christou-Ergos, Maria and Sabahelzain, Majdi M. and Steffens, Maryke and Kaufman, Jessica and Bolsewicz, Katarzyna T. and Danchin, Margie and Leask, Julie, The Drivers of Influenza Vaccination in Adults: Insights from a National Australian Survey (August 26, 2024).
Abstract
Influenza vaccination coverage is suboptimal in the Australian adult population. While coverage data is used to monitor uptake, at present, there is no systematic data collection on the behavioural and social drivers of vaccination. This study used a globally standardized survey tool to measure constructs related to influenza vaccination within four domains (i) vaccination-related thoughts and feelings, (ii) social processes, (iii) motivation, and (iv) practical issues.
An online survey was administered to a sample of 2055 Australian adults recruited via an online panel in March 2024. Logistic regression analysis was used to determine factors that contributed to people’s intention to receive an influenza vaccine.
Most Australian adults (62.8%) wanted an influenza vaccine in the upcoming influenza season. The odds of wanting an influenza vaccine were significantly greater for people who: had received an influenza vaccine in the preceding two years (aOR:10.35; 95% CI: 7.09-15.11) p<.001; thought the influenza vaccine offered personal protection (aOR:2.66; 95% CI: 1.76-4.01) p<.001; thought the influenza vaccine offered protection to others (aOR:1.6; 95% CI: 1.08-2.39) p=0.02; thought the influenza vaccine was important for their own health (aOR:1.53; 95% CI: 1.03-2.27) p=0.04; felt a social responsibility to get an influenza vaccine (aOR:4.05; 95% CI: 2.88-5.68) p<.001; believed close family and friends wanted them to get the influenza vaccine (aOR:2.35; 95% CI: 1.67-3.3) p<.001; believed community leaders wanted them to get the influenza vaccine (aOR:1.48; 95% CI: 1.08-2.01) p=0.01; received a recommendation to get the influenza vaccine from a health care worker in last two years (aOR:1.7; 95% CI: 1.24-2.32) p<.001.
This study provides a foundation for ongoing national monitoring of the drivers of influenza vaccination. This will help tailor timely strategies to population needs. Strategies that increase confidence in the value of vaccination, foster positive social norms within communities and increase access to vaccine services may help increase influenza vaccine acceptance.
Leask, Julie and Christou-Ergos, Maria and Abdi, Ikram and Mbossou, Franck and Sabahelzain, Majdi M. and Wiley, Kerrie and Lambach, Philipp and Sim, So Yoon, Informing the Development of Transmission Modelling Guidance for Global Immunization Decision-Making: A Qualitative Needs Assessment (August 26, 2024). Available at SSRN:
Abstract
In recent years, mathematical transmission models have been increasingly used to support immunization program decisions and to measure the impact and cost-effectiveness of interventions. However, countries face expertise-and resource-related barriers that limit the use and application of modelled evidence to inform decisions. The World Health Organization (WHO) established an Immunization and Vaccines Related Implementation Research advisory committee subgroup in 2023 to support immunization decision-makers to effectively generate, translate and use such evidence for strategies, policies, and programs. This study supports this effort, detailing the needs of end-users to inform content and format of the guidance.
Fifteen in-depth interviews were conducted with vaccination decision-makers and modellers from all WHO regions and across low-,middle- and high-income countries. Interviews explored: (i) how modelling is understood and used; (ii) the challenges faced when using modelled evidence; (iii) the types of guidance that would be most useful to enhance the use of modelled evidence. Analysis of transcripts was guided by the framework method.
Participants with modelling expertise used it firsthand, systematically, and often in an advisory capacity. Less experienced users, often in policy advisory roles, were less confident in their understanding of modelling and some did not use it at all. Decision-makers with little or no modelling experience cited a need for more information to help them understand the value of modelling in their context and many supported its potential. All participants saw a need for capacity strengthening and localised application to instil confidence in using modelled evidence. Those with less experience expressed a need for ongoing interactive engagement with knowledge brokers and training.
Timor-Leste has succeeded in controlling several diseases, including polio, maternal and neonatal tetanus, and endemic measles and rubella. The country has also introduced several new vaccines in recent years, mostly recently HPV vaccination in a very successful rollout. The Ministry of Health requested a joint national / international review of the Expanded Programme on Immunization and vaccine preventable disease surveillance system in Timor Leste (EPI review). The review also combined a post-introduction evaluation for pneumococcal conjugate vaccine and COVID-19 vaccine. The international review team included: Professor Julie Leask (SPH), Dr Dijana Spasenoska, (WHO HQ), Dr Tondo Opute Emmanuel Njambe and Dr Sigrun Roesel (WHO SEARO), Dr Sarah Sheridan and Dr Ann Burton (NCIRS), Dr Monica Shah and Dr Michael Lynch (US CDC), Dr Jobayer Al Mamum (WHO Bangladesh), Dr Jeffrey Jap (East Nusa Tenggara PHO), Dr Khin Devi Aung (UNICEF EAPRO) and Dr Ratih Oktri Nanda (MoH Indonesia). It was coordinated by the World Health Organization HQ, Regional Office for Southeast Asia, and Timor Leste Country Office.
This was an intense two weeks of fieldwork, debriefing and reporting held from 14th to 25th October. Seven teams comprising international reviewers, Ministry of Health staff, and WHO consultants visited 13 municipalities, 73 health facilities and did 14 national-level interviews. They synthesised findings and recommendations over two days and presented them to the Minister for Health, Hon Dr Élia António de Araújo dos Reis Amaral, her ministry, and key partners.
The review recommended strengthening several areas: staff orientation and supportive supervision, updating and supply of guidelines and forms, waste management, strengthened cold chain monitoring, follow-up of missed children, outreach, coverage assessment, adverse events response, and strengthening the system for working with community volunteers. These build on many strengths, including the commitment and existing expertise of staff throughout the program. Detailed findings of this review will inform the National Immunisation Strategy, 2025-2029.
Last week, several of the SABII team presented at the 2024 Communicable Diseases and Immunisation Conference, hosted in Brisbane, Queensland. This year’s theme was Protecting Communities: Empowering Health through Disease Control and Immunisation’.
Rebika Nepali outlines a few of the conference highlights below:
I had such an enriching experience attending the Communicable Diseases and Immunisation Conference 2024, Brisbane. I had the great opportunity to network with many inspiring individuals. Some key highlights from the conference include (my personal experience):
Speaker Tiahni Adamson shed light on “Caring for the country in a climate crisis” with insights from the First Nations community and emphasised how listening to the needs of people is important in decision-making.
As we know 2024 is 50th anniversary of “Expanded Program on Immunisation” EPI, Journey from Smallpox and Polio eradication and prospects for Measles elimination by Professor Peter McIntyre is worth reflecting on.
In collaboration with Universitas Indonesia and Unicef, SABII have published a report titled, Perceptions and demand for routine immunization and other maternal and child health services during COVID-19 pandemic among caregivers and healthcare providers in Indonesia.
Authored by: Madeleine Randell, Meru Sheel, Michelle Dynes, Oktarinda, Fitriyani Fitriyani, Lintang Saraswati, Kylie Jenkins, Adeline Tinessia, Mu Li, Margie Danchin, Julie Leask, Tri Yunis Miko Wahyono.
Project description:
The COVID-19 pandemic had a significant impact on maternal and child health services in Indonesia. This was due to reduced access to key services as well as fear of COVID-19 driving reluctance to attend services. One outcome of this was a decline in routine immunisation coverage among young children. Despite a COVID-19 vaccine roll-out in January 2021, only 66% of adults had received their second dose and 20% had received their third dose by April 2022.
This study aimed to better understand the influence of the COVID-19 pandemic on access to routine immunization, other maternal and child health services and COVID-19 vaccination amongst caregivers of young children and healthcare providers in Central Java and West Nusa Tenggara, Indonesia. We used the BeSD surveys with additional questions developed with a technical advisory group. In total, 1399 caregivers and 604 healthcare providers from eight districts across two provinces, i.e., Central Java and West Nusa Tenggara, participated in a cross-sectional survey.
Executive Summary below. Click here to download the full report.
Executive Summary
This study aimed to better understand the influence of the COVID-19 pandemic on access to routine immunization, other maternal and child health services and COVID-19 vaccination amongst caregivers of young children and healthcare providers in Central Java and West Nusa Tenggara, Indonesia. In total, 1399 caregivers and 604 healthcare providers from eight districts or cities across the two provinces, Central Java and West Nusa Tenggara, participated. Data collection of the study was conducted in March to April 2022.
The University of Sydney and Universitas Indonesia undertook this research on behalf of UNICEF East Asia Pacific Regional Office (EAPRO). A technical advisory group with members from Centers for Disease Control and Prevention Indonesia and the US Centres of Diseases Control and Prevention (here after USCDC), Indonesian National Ministry of Health, UNICEF Indonesia, and WHO Indonesia provided regular advice.
In related news, Madeleine, Adeline and Julie have another publication coming out soon in BMJ Global Health. Stay tuned:
A huge congratulations to the recently graduated Dr Catherine Helps.
Dr Helps’ thesis is titled: Gaining insight into the refusal of childhood vaccinations – from birth to five years old-in the Byron Shire Community and can be accessed via the University of Sydney library here.
Abstract:
The introduction of public vaccination campaigns in the mid-20th century led to a dramatic reduction of mortality and morbidity from the previously common infectious diseases of childhood. Safe and effective protection from infectious diseases through vaccination is now available to all Australian children. While historically less than two percent of parents in Australia decline vaccination, there are some communities with higher rates of childhood vaccination refusal with potentially negative health consequences for the individual child and other community members, especially where there is geographical clustering of low vaccination uptake. The Byron Shire is such a community recording registered refusal rates of over 30 per cent over the period in which conscientious objection (CO) data were gathered (1999 – 2016). Encouraging vaccine uptake in effective and ethical ways requires an understanding of the decision-making pathways of non-vaccinating parents. This thesis uses qualitative data collected in the Byron Shire from 2016 – 2023 to explore childhood vaccination refusal within this community, and to inform effective therapeutic encounters and the targeting of future public health interventions. Two key concepts were derived from this research. Firstly, that of decisional conflict which summarises the position and experiences of non-vaccinating parents. Secondly, that adherence to the principles of engage, inform and encourage is advised for health professionals’, policy makers and others in their interactions with non-vaccinating parents. These concepts form the basis of the conclusions and the recommendations presented in this thesis. While this research was conducted in a community identified as a cluster of lower vaccination uptake, the experiences of decisional conflict in non-vaccinating parents and recommendations for health professionals to engage, inform and encourage may be applicable more broadly to vaccine-hesitant or refusing parents.
SABII co-lead recently visited Tanzania as part of multi-disciplinary One Health research towards sustainable aquaculture.
Sydney ID’s Dr Kerrie Wiley from Sydney School of Public and Dr Francisca Samsing Pedrals from Sydney School of Veterinary Science recently travelled to Tanzania as part of a multi-disciplinary team using a One Health lens to identify priority challenges for sustainable aquaculture industry growth in the Lake Victoria region, made possible through a University of Sydney – University of Glasgow Ignition Grant.
Sydney Infectious Diseases Institute
